///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Anesthetic Implications of a Parturient with Neurofibromatosis (Type 2) requiring Cesarean Section

Abstract Number: 173
Abstract Type: Case Report/Case Series

Toby C Thomas MBBS, BSc1 ; Caroline S Grange MBBS2

Introduction: Neurofibromatosis type 2 (NF2) is a rare inherited disorder characterised by a tendency to form tumors associated with nervous tissue / other organs. Although regional anesthesia (RA) has been described previously (1), pregnancy may stimulate tumor growth, thereby increasing risk of neural injury.

Case Report: A 34 year old primagravida with a history of NF2 and Crohns disease was assessed at 32 weeks gestation. NF2 had been diagnosed 18 months earlier, following an episode of left-sided facial numbness and ptosis, and right-sided facial weakness. Bilateral acoustic schwannomas, multiple posterior fossa neuromas and several intracranial meningiomas were demonstrated by MRI. Spinal neuromas were also present at the proximal brachial plexus, in addition to a thoracic meningioma (T7), and a schwannoma of the right L5/S1 nerve root. Intracranial pressure was normal and complete resolution of symptoms occurred within 3 months of initial presentation.

Cesarean section (CS) was planned at 38 weeks gestation due to breech presentation. Spinal anesthesia was considered but dismissed due to concerns surrounding cerebral spinal fluid drainage, given the multitude of intracranial tumors. Although epidural anesthesia may have been possible, potential risks of nerve injury (posed by the L5/S1 lesion) or accidental dural puncture were considered too great. General anesthesia was therefore chosen. Following antacid prophylaxis, anesthesia was induced with thiopentone (500mg) and succinylcholine (150mg), and maintained with isoflurane, nitrous oxide and oxygen. Surgery was uneventful and resulted in delivery of a female infant (Apgars 10, 10 at 1, 5 minutes respectively). Post-operative recovery was unremarkable. A MRI scan (8 weeks postpartum) revealed significant enlargement of the L5/S1 lesion with both extradural and intradural extension (not present on pre-natal scans).

Discussion: This case highlights the potential hazards associated with RA in parturients with NF2. Pre-natal central nervous system imaging is important to demonstrate lesions present (2). However, as tumor growth may be accelerated during pregnancy (3), imaging immediately prior to undertaking RA should be considered.

References:

1.Sakai T, Vallejo MC, Shannon KT. Int J Obstet Anesth 2005;14:332-35.

2.Hirsch NP, Murphy A, Radcliffe JJ. Br J Anaesth 2001;86:555-64.

3.Patel AK, Alexander TH et al. Laryngoscope 2008;118:1458-63.



SOAP 2009